key concepts

• Ottowa ankle rules: bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step
• It is important to perform a chest X-ray to look for TB prior to starting biologics for rheumatoid arthritis as they can cause reactivation
• Haemochromatosis is a risk factor for pseudogout
• MRI is the most appropriate imaging modality to diagnose meniscal tears
• Inflammatory back pain (e.g. ankylosing spondylitis) typically improves with exercise
• Diffuse cutaneous systemic sclerosis is associated with anti Scl-70 antibodies
• Rheumatoid arthritis: initial management is conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid
• Paget's disease - old man, bone pain, raised ALP
• Over 99% of patients with SLE are ANA positive, therefore it is a useful rule out test
• Osteomalacia is managed using vitamin D supplementation (often with an initial loading dose regime)
• Pain on the radial side of the wrist/tenderness over the radial styloid process ? De Quervain's tenosynovitis
• A Z-score is helpful in diagnosing secondary osteoporosis and should always be used for children, young adults, pre-menopausal women and men under the age of 50
• X-ray of the spine is the first-line investigation for a suspected osteoporotic vertebral fracture
• Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis
• S1 lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
• NICE recommend co-prescribing a PPI with NSAIDs in all patients with osteoarthritis
• Chronic kidney disease is a risk factor for osteoporosis
• One of the cardiac complications of Ehler-Danlos is aortic regurgitation
• A patient with a subtrochanteric femoral fracture fixed with intramedullary nail should weight bear immediately after the operation
• Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of ankylosing spondylitis
• Raised serum calcium, low serum phosphate, raised ALP and raised PTH - primary hyperparathyroidism
• Arterial/venous thrombosis, miscarriage, livedo reticularis → anticardiolipin antibody +ve
• Type I hypersensitivity reaction - anaphylaxis
• Creatine kinase is normal in polymyalgia rheumatica
• External rotation (on both active and passive movement) is classically impaired in adhesive capsulitis
• Ankylosing spondylitis features - the 'A's 

  • Apical fibrosis
  • Anterior uveitis
  • Aortic regurgitation
  • Achilles tendonitis
  • AV node block
  • Amyloidosis
• Start alendronate in patients >= 75 years following a fragility fracture, without waiting for a DEXA scan
• Bony tenderness at either malleolus and inability to weight bear indicate need for ankle x-ray
• In discitis due to Staphylococcus an echo is needed to look for endocarditis
• Adequate analgesia is vital in rib fractures to ensure breathing is not affected by pain; inadequate ventilation may predispose to chest infections
• Ultrasound is the initial imaging modality of choice for suspected Achilles tendon rupture
• An iliofascial nerve block is an effective and commonly used method of analgesia for patients with a neck of femur fracture
• Biceps rupture may lead to a 'Popeye' deformity in the middle of the upper arm
• A positive femoral nerve stretch test may indicate referred lumbar spine pain as a cause of hip pain
• Glucocorticoids should be given once a diagnosis of temporal arteritis is suspected - don't wait for the temporal artery biopsy etc